{"id":30927,"date":"2014-01-21T15:03:06","date_gmt":"2014-01-21T14:03:06","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=30927"},"modified":"2015-09-22T14:36:19","modified_gmt":"2015-09-22T13:36:19","slug":"william-cayley-evidence-based-medicine-and-practice-change-get-out-front-and-push","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2014\/01\/21\/william-cayley-evidence-based-medicine-and-practice-change-get-out-front-and-push\/","title":{"rendered":"William Cayley: Evidence based medicine and practice change\u2014get out front and push!"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-26868\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2013\/06\/bill_cayley.jpg\" alt=\"bill_cayley\" width=\"160\" height=\"130\" \/><\/p>\n<p>We\u2019d hoped evidence based medicine (EBM) would improve patient oriented outcomes and clinical processes, but <a href=\"http:\/\/www.bmj.com\/content\/348\/bmj.g22\">some fear the \u201cEBM\u201d movement is broken<\/a>. However, it may not be just \u201cEBM\u201d as a movement that is broken\u2014I am starting to wonder more and more about clinicians\u2019 willingness or ability to apply evidence in practice, when it runs counter to usual practice or our expectations of what it means to be sick.<!--more--><\/p>\n<p>&nbsp;<\/p>\n<ul>\n<li>Despite the most recent <a href=\"http:\/\/annals.org\/article.aspx?articleid=1033137\">American College of Physicians guidelines<\/a> recommending \u201cagainst the use of mechanical prophylaxis with graduated compression stockings for prevention of venous thromboembolism,\u201d performance improvement pressure at local hospitals has led to nearly universal application of mechanical thromboembolism prophylaxis to all medical inpatients.<\/li>\n<li><a href=\"http:\/\/www.jfponline.com\/the-publication\/past-issue-single-view\/should-patients-with-acute-dvt-limit-activity\/0559402467a8232f1309e2d27bd42482.html\">There is fairly clear evidence<\/a> not only that \u201cAmbulation, combined with compression of the affected extremity, appears to be safe for medically stable patients with deep venous thrombosis,\u201d but also that \u201cLeg compression and ambulation, compared with bed rest without compression, can effectively decrease swelling and pain.\u201d This evidence has been building for over 10 years, yet I recently encountered a patient with a new thrombus, who\u2019d been advised to nearly completely limit activity for at least two weeks.<\/li>\n<li>Oral rehydration is an effective and safe (and less invasive) <a href=\"http:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/14651858.CD004390.pub2\/abstract\">method of treating mild to moderate dehydration<\/a>, yet treatment of most dehydrated kids in \u201cdeveloped\u201d countries still seems to jump straight to the intravenous route.<\/li>\n<li>Despite the fact that metformin is recommended as the first-line oral treatment for type 2 diabetes, disproportionate <a href=\"http:\/\/www.jabfm.org\/content\/27\/1\/136.full\">concerns over side effects<\/a> and contraindications continue to lead to underutilization. The process of change is always hard, and implementing change in the face of inertia or tradition (or even local convention) can be harder still. Doctors, however, are not called to simply follow the crowd\u2014doctors are called to be leaders and (going back to the Latin roots of the word),<em> teachers.<\/em><\/li>\n<\/ul>\n<p>We need to work not only to reclaim the original visions of the evidence based medicine movement, we also need to encourage critical appraisal <em>and implementation <\/em>of the current evidence.<\/p>\n<p>I\u2019ve heard it said that you don\u2019t want to be the first person to adopt something new, but neither do you want to be the last. However, when there is clear evidence in the literature for a better way forward, it behoves us as physicians to at least get out in the front and push for change.<\/p>\n<p><em>Competing interests: \u201cI declare that that I have read and understood the BMJ Group policy on declaration of interests and I have no relevant interests to declare beyond a passion for clear and critical thinking.\u201d<\/em><\/p>\n<p><em><strong>William E Cayley Jr<\/strong> practises at the Augusta Family Medicine Clinic, teaches at the Eau Claire Family Medicine Residency, and is a professor at the University of Wisconsin, Department of Family Medicine. <\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>We\u2019d hoped evidence based medicine (EBM) would improve patient oriented outcomes and clinical processes, but some fear the \u201cEBM\u201d movement is broken. However, it may not be just \u201cEBM\u201d as [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2014\/01\/21\/william-cayley-evidence-based-medicine-and-practice-change-get-out-front-and-push\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1357,14769],"tags":[],"class_list":["post-30927","post","type-post","status-publish","format-standard","hentry","category-us-health-care","category-william-cayley"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>William Cayley: Evidence based medicine and practice change\u2014get out front and push! - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2014\/01\/21\/william-cayley-evidence-based-medicine-and-practice-change-get-out-front-and-push\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"William Cayley: Evidence based medicine and practice change\u2014get out front and push! - The BMJ\" \/>\n<meta property=\"og:description\" content=\"We\u2019d hoped evidence based medicine (EBM) would improve patient oriented outcomes and clinical processes, but some fear the \u201cEBM\u201d movement is broken. 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